2 April 2012

Will striking down Obamacare will lead to a single-payer system?

What happens if the Supreme Court strikes down the Affordable Care Act — aka Obamacare — in part or entirely?

One body of opinion, typified by E.J. Dionne Jr., holds that a single-payer system becomes more likely if the individual mandate is struck down:

The irony is that if the court’s conservatives overthrow the mandate, they will hasten the arrival of a more government-heavy system. Justice Anthony Kennedy even hinted that it might be more “honest” if government simply used “the tax power to raise revenue and to just have a national health service, single-payer.” Remember those words.

Remember, too, the gulf between sound policy and what is possible, or thought to be possible, politically.

Obamacare keeps in place, but attempts to reform, a health care funding system employing private health insurance. Obama thought it would appease Republicans and earn significant bipartisan support, but of course it didn’t. It simply allowed the health insurance industry to continue converting premiums to profits, driving up the cost of health care. A health care system based on private insurance is not sustainable, and it’s morally reprehensible.

In an everyone and everything covered, government run, single-payer system funded by progressive taxes, there’s no need for private health insurance. Combining that with an end to fee for service, and other reforms, would bring economic efficiencies that could obviate any need for co-payments. That’s not pie-in-the-sky. Other nations have proved the viability of single-payer systems.

If I thought that striking down Obamacare, or at least the individual mandate (which I find loathsome), would hasten the adoption of a national single-payer plan, I’d be rooting for Justice Kennedy to join Justice Scalia’s gang and throw out everything: the bathtub, the bathwater, and the baby.

But an end to Obamacare is not likely to usher in the era of single-payer sanity anytime soon, reports Talking Points Memo’s Sahil Kapur:

“Not in my lifetime. There just isn’t the political support,” Tim Jost, a law professor at Washington and Lee University and a supporter of the Affordable Care Act, told TPM. “We could not even get a public option when the Democrats had 60 Senate votes. The alternative is to limp along with an ever larger share of Americans receiving ever less care. This doesn’t seem to bother a lot of Americans, at least those who pay for political advertising.”

“I think that is naive,” Jonathan Gruber, an MIT professor and health policy expert, told TPM. “If you look at the history of health care reform, every time we come back to it the proposals are more conservative than the last time.”

Gruber’s right. Despite the policy superiority of single-payer, and the success of Medicare, the Democratic Party began chickening-out on promoting it. In the Democratic Party’s 1972 platform, we find this statement under Rights, Power, and Social Justice:

“We therefore urge the Democratic Party to adopt the principle that America has a responsibility to offer every American family the best in health care, whenever they need it, regardless of income or any other factor. We must devise a system which will assure that . . . every American receives comprehensive health services from the day he is born to the day he dies, with an emphasis on preventive care to keep him healthy.”-Joint Statement of Senator Edward M. Kennedy and Representative Wilbur Mills, St. Louis Hearing, June 17, 1972.

Kennedy’s and Mill’s statement had clarity, but it was a decoy. The actual platform avoided any commitment to a single-payer system. Twenty years later, the 1992 platform introduced us to Affordable Health Care, Bill and Hillary Clinton’s weasel-words for a hideously complicated private insurance based health care system for those not eligible for Medicare:

All Americans should have universal access to quality, affordable health care — not as a privilege, but as a right. That requires tough controls on health costs, which are rising at two to three times the rate of inflation, terrorizing American families and businesses and depriving millions of the care they need. We will enact a uniquely American reform of the health care system to control costs and make health care affordable; ensure quality and choice of health care providers; cover all Americans regardless of preexisting conditions; squeeze out waste, bureaucracy and abuse; improve primary and preventive care including child immunization and prevention of diseases like Tuberculosis now becoming rampant in our cities; provide expanded education on the relationship between diet and health; expand access to mental health treatment services; provide a safety net through support of public hospitals; provide for the full range of reproductive choice—education, counseling, access to contraceptives, and the right to a safe, legal abortion; expand medical research; and provide more long term care, including home health care.

Sixteen years later, “affordable health care — not as a privilege, but as a right” was gone from the 2008 Democratic platform. The party’s transition from New Deal social justice to market based freedom of choice was complete. Here’s a sample from that platform’s 1,700-word health care plank:

Covering All Americans and Providing Real Choices of Affordable Health Insurance Options. Families and individuals should have the option of keeping the coverage they have or choosing from a wide array of health insurance plans, including many private health insurance options and a public plan. Coverage should be made affordable for all Americans with subsidies provided through tax credits and other means.

Shared Responsibility. Health care should be a shared responsibility between employers, workers, insurers, providers and government. All Americans should have coverage they can afford; employers should have incentives to provide coverage to their workers; insurers and providers should ensure high quality affordable care; and the government should ensure that health insurance is affordable and provides meaningful coverage. As affordable coverage is made available, individuals should purchase health insurance and take steps to lead healthy lives.

That led to Obamacare, a plan based on a scheme devised by the deeply conservative Heritage Institute and passed over the objections of howling at the moon mad Republicans and some almost as deranged Blue Dog Democrats. I still think more was possible, but pusillanimous Democrats quavered at all progressive proposals, and the White House sold the public option and leverage on drug prices down the river in secret deals.

Only a fool would expect these people to say, “Okay, private insurance has had its chance. Now we’re giving you a single-payer system,” if the Supreme Court strikes down Obamacare. A more likely reaction from Democrats is, “Well, we tried, and we promise not to try again.”

That would be fine with the tea-soaked, social Darwinist, Republican Party, which believes that people, especially illegal immigrants, who suffer or die because they can’t afford health insurance — and as many as 50,000 a year do die for that reason — are feckless souls whose fate is willed by God.

So, I’m not rooting for the Supreme Court to throw out Obamacare. But neither will I cheer if the White House wins. Even if Obamacare survives its test in court, it will never — by design — cover millions. And eventually, it will collapse under the weight of supporting the profits of the parasitical health insurance industry.

I never expected anything else from the Republicans. But I did from the Democrats. Obamacare cured me of that hope.